An Iranian Waterbirth

If you haven't yet, go read Andrea Robertson's account of the recent Iranian waterbirth.

Reading stuff like this makes me really feel like there IS hope for birth.

Amniotomy

The latest from the Cochrane Review.

Breaking The Waters During Labor No Longer Recommended

17 Oct 2007

"We do not recommend that amniotomy, also known as breaking the waters, should be used routinely as part of standard labour management and care" says Cochrane Researcher Rebecca Smyth, after completing a systematic review of relevant research studies. "Women should be informed that it doesn't shorten the first or second stage of labour, it doesn't affect the woman's satisfaction with her childbirth experience, and doesn't result in the child being in better condition immediately after birth."

This Cochrane Systematic Review found that breaking the waters may be associated with a slightly (non-significantly) higher rate of Caesarean section. Breaking the waters may cause changes in the baby's heart rate.

The aim of breaking the waters is to speed up and strengthen contractions, with the intention of shortening labour. The membranes are punctured using a long handled hook, and it is thought that hormones in the amniotic fluid that flows out will stimulate contractions. In some centres, it is performed as a routine part of care for all women in labour -- in others it is used only for women with a clinical need to have their waters broken.

Ms Smyth came to these conclusions after she and colleagues had identified 14 relevant studies that involved almost 5,000 women. The overall quality of the studies was variable, making it difficult for the group to give firm recommendations about the use of amniotomy. There is a need for further research in this area.

"Our evidence suggesting this lack of effect should be discussed with women in the antenatal period," says Smyth.

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Article adapted by Medical News Today from original press release.

A totally rockin' breastfeeding article!!

Dr. Jack Newman and Edith Kernerman talk about breastfeeding and answer mothers' questions here.

A little long, but well worth the read. There were some really choice quotes from Dr. Newman in here!

Dr. John

If you have never read any of Dr. John Stevenson's writing, then here is a gem to start with.

Enjoy!!

Re-evaluating

I have been spending the last few days really considering what I want this blog to become.

I have such a hard-to-beat inclination to talk about what other midwives do/don't do in a critical way, mainly due to my own struggle to come to grips with the reality of maternity care, midwives included.

But, I don't want this blog to be about my judgement (that is what it is, essentially) of others. I want this blog to be about my own journey as a midwife and my own ideas. More "I" statements than "they" statements. LOL!

Often I feel compelled to post here about various topics because of an encounter with someone or something that I am in disagreement with. So, I will have to carefully check my tendencies to rant on and on about such things because I have been feeling like there is enough out there on the net and in books that bashes what others are doing. I want my blog to approach birth and midwifery from a positive light, spoken more from my heart and mind.

birth magazines

I'm not sure if Midwifery Today has changed, or if it is my perspective that has changed, but I can no longer devour each new edition that comes out and be left feeling excited and content.

I still love Midwifery Today, of course, and have great respect for their publication and recognize them as the great resource that they are. But lately, almost every article I read in each new edition makes me cringe at some point.

I know I have said it before, but it feels like the more I read other midwives' work or talk with other midwives, the more it has become glaringly obvious how far on the fringe I am in regards to my approach to birth.

I am tired of hearing midwives say that they trust birth and that birth is a normal and natural process, when they turn right around and start trying to convince everyone about how their interventions to 'help' the situation was natural because it only involved their hands (not a knife) and how midwives are needed to save birth, and so on. If birth works so well, then why do some midwives consider it dangerous to give birth with no trained professional?

I have to say....what is up with all of the bed births? Seriously! I'm not just talking about the birth pictures always featured on the inside back cover (which are almost always in bed, with lots of hands on the baby's crowning head and perineum), but about the birth stories themselves. I know that there are women who truly do choose to give birth laying down, and that is fine by me, but I am positive that they are in the very small minority. I think that more often than not, the bed becomes the chosen birth place because it is never presented to the woman as the least ideal place for giving birth (physiologically speaking). Though, again, I don't think that the birth pictures are a reflection of Midwifery Today's philosophy, but probably they print whichever pictures are received, and most of what they receive are bed births.

I am still a devoted reader of Midwifery Today, and I have been wanting to write an article to submit, as I don't think it is productive if all I do is complain about the situation. I have been brain-storming all night about which topic I should write about. Really, my issue I suppose lies more with the reality that I am facing: that the majority of midwives out there from what I can tell approach midwifery and birth very differently than I do. This is something that I am having a hard time coming to grips with, I suppose.

Elephant Suckling

"Elephant milk looks rather thin and watery but it is very nourishing and babies put on weight at a rate of 22-44 lb per month. They tend to suckle little and often."

From Eyewitness Books: Elepahant

Our mammal sisters have so much to teach us.

Perineums

Everyone has heard a story of a birth where the perineum was "tight" and just wouldn't stretch to allow the head to be fully born, and the midwife (or doctor) just had to either cut an episiotomy (it makes me wince to even consider) or massage it back around the baby's head.

Does this make biological sense? This makes as much sense as saying that a baby won't breath properly if not suctioned. ???? Um, no.

Any perineum that hasn't been mutilated by FGM will stretch as needed to birth a baby. Perhaps those women who have these so called 'tight' perineums need to be given more privacy, perineums unobserved, to give birth.

Sort of how our vaginas are soft and open up to our lover's touch but tense up when a stranger inserts a speculum.

conference fun

I really love going to conferences. Meeting new people, catching up with old friends, hearing speakers on hopefully amazing topics. It just makes me happy.

I am lucky enough to live within a reasonable driving distance of the Gentle Birth World Congress conference which happened this last weekend. Though I only registered for the neonatal resuscitation training during a pre-conference session, I ended up spending Thursday through Sunday there, just hanging out, talking with people, walking around the free baby expo, and seeing the (free) birth and breastfeeding videos. I drove lots and lots of miles to make it happen, but it was fun and totally worth it! I say that even though I didn't actually attend any of the conference sessions. lol!

It just makes me even more excited about the Trust Birth Conference happenings!

breastfeeding again

I am just blown away. Seriously! What is up with the pervasive amount of mis-information about breastfeeding???? Even from alternative health care practitioners......

In the last few days, I have talked with 2 different moms.

First mom's baby is about a month old. At 2 weeks old, she took her baby to the 'breastfeeding clinic' class that takes place twice a week at our local hospital. The lactation consultants there (called lactation specialists on their website, so probably not IBCLCs) determined that because she didn't gain much after nursing (leisurely) for 20 minutes, that the mother's supply was inadequate. Baby was fine otherwise, good output (wet/poopy diapers) thriving in all other aspects, not loosing weight, etc. They sent her home with formula (!!), a nipple shield (not surprising) and a SNS (which they didn't show her how to use at all). When I hear crap like this, I just want to throw up. Oh my. :( She had never tried the SNS because she had no idea how to use it. Of course, she could have gone back and asked for help, but why the hell would you give a mom (who you believe to have a low supply) a SNS without showing her HOW to use it????

This breastfeeding clinic consists of stripping baby down, weighing baby, nursing baby, then weighing baby. Then being told that you either have enough milk or don't. Total nonsense. That coupled with their love of handing out nipple shields like there is no tomorrow, and, I admit it, I have a very strong dislike of the class.

The second mom has a week old baby, and was having horrible sore nipples. Her midwife suggested giving her nipples a rest for a few days, and just pump or hand express milk and gave her a syringe feeder to feed her baby. Then, at a week, when it was apparent that the baby wasn't gaining, and was still loosing weight, she suggested she supplement with goat's milk. :( I can't be the only one who sees problems with this advice. It's the latch! It's the latch!! A poor latch will of course cause sore nipples. It will also lead to the baby not getting as much milk, and, because the breasts aren't being effectively drained, to a low milk supply. Which is where the mom is at now. Her supply is low, her baby is still losing weight. :( While I understand that you want to give mom a break from the horrible pain of sore nipples, stopping nursing is a very poor solution. It too will more often than not lead to low supply. Fixing the latch is the best solution for both mom and baby.

She took her baby in to see a naturopath doctor (who also happens to attend homebirths) and he told her that because she never experienced any physical breast changes (tenderness, growth, etc.) during pregnancy, she would never make enough milk. He suggested that it was perhaps because she had a lot of stress going on in her life during her pregnancy. What the....???? There have been studies that have shown that prenatal breast changes are NOT associated with milk supply at all. And, the bit about stress? In my opinion, a large number of women have a lot of stress during pregnancy. It seems that so much transitions and life changes suddenly occur when a woman is pregnant: moving, job changes, financial worries, and so on. If stress caused us to not make milk that easily, low milk supply would be a true problem for numerous women. Well, I guess low milk supply IS a common breastfeeding problem, but that is because of a whole other set of reasons (scheduled feedings, supplementing, poor latch, etc.).

It feels like there are so many factors that really undermine breastfeeding in our culture. Can I at least have hope that it won't last forever? Because I do, I really do.

Birth Philosophy

I have been spending lots of free time looking at all different midwives' websites while preparing to start creating my own website. What has struck me more than anything is the similarity of all of the 'philosophies'. I know from experience that many (most?) people assume that a midwife is a midwife is a midwife. Of course, that is not the case at all. But, when you ask midwives about their birth philosophies, they almost all include some talk about birth being natural, birth working best left alone, their role is to support the woman/family, about promoting calm/gentle birth, etc.

You will never see a midwife say that she believes birth works, but only if she does "X" (perineal support/massage, vaginal exams, hat on baby right after birth, test your glucose levels prenatally, and so on).

So, when pondering about how I can word my own philosophy on birth, I am struck with the fact that I am just restating the same old lines. However, the more that I read/hear/talk with other midwives, the more I feel very much like the odd ball. How can there be this disconnect?

Practice Philosophy

My practice philosophy has been on my mind lots lately. Not just my general, overall philosophy, because I feel very sure of that. I support women in their informed choices, birth unfolds best left alone, and essentially, I do want to be what is termed a 'hands-off' midwife.

But, I have been thinking more and more about the lovely details. Different situations, how I would react in various circumstances. How much nutritional counseling do I want to offer? Which pregnancy/birth/breastfeeding books do I want to give to all clients? How will I approach clients who have failed to hold up their agreed upon payments? Will I use a doppler prenatally if clients choose it?

I need to start writing all of this down. It is, of course, one of my assignments for school (to create a thorough Principles of Practice), but I would want to do it anyways. Getting computer time for it seems so scare. I have been considering hand writing it all, and then typing it up later.

Another thing I have really been wanting to get started is a website. There is no rush, as I am not taking clients of my own for a little while still, but it is something that gets me all excited! The main thing holding me back is the fact that I must choose a domain name. I have a very hard time with such things. It is right up there with the name of my future practice. I have NO idea. I am hoping that the right name will just 'appear'. Maybe the universe will send it to me in my dreams. I can dream, right?

Baby girl born unassisted

I got word today that the sweet couple for whom we were on call as back-up for their UC had their baby girl early this morning. :) So very sweet. I knew it would go perfectly and they wouldn't need us.

Apprentices

It feels more and more like so many midwives do not show fair amounts of respect to their apprentices. I hear more and more of apprentices who are made to the grunt work, asked to do all sorts of things (not midwifery related), and aren't paid.

I don't mean to say that it is unreasonable for apprentices to do ALL aspects of midwifery, including the grunt work; of course, she should do her best to help the midwives as much as is reasonable and to experience all the work involved in being a midwife. But it often seems like the apprentice is treated with little regard.

I understand, too, that not all midwives can afford to pay their apprentices, and that the midwives are offering a huge amount of learning to the apprentice. But, there does come a point where the apprentice is quite valuable to the midwife, not just a bystander watching to learn. At this point, it does seem only fair to give the apprentice some sort of pay, even if it is $20 per birth. It isn't so much about the money as it is the act.

I feel extremely blessed to be working with a midwife who respects and values me as much as I respect and value her. She does pay me a very generous amount to assist her at births, more now that I am acting as the primary midwife during prenatal and antenatal care. For this, I am grateful beyond words. Because of my experience, I fully intend to do the same for my future apprentices.

I am just tired of hearing about midwives who are asked (more often, expected!) to organize the midwife's (personal) files, run (personal) errands for her. Midwives and apprentices both have so much value and ought to have mutual respect and admiration.

Aunt Orlene

Granny midwife Orlean Puckett.

I just cannot even fathom losing 24 of my own babies.

nipple shield fun

Our local hospital has a breastfeeding class twice a week, consisting of everyone undressing their babies, weighing their babies, nursing their babies, then weighing the babies again. This is to make sure they 'have enough milk'. The lactation consultants (most of whom are IBCLCs) seem to hand out nipple shields like there is no tomorrow.

These 2 facts make somewhat despise the this 'class'. I have yet to see a mom go there and come away with helpful, sane information. It really just makes me want to pull my hair out in frustration! It makes it even harder when clients go there for help, without ever calling us to tell us they are having problems, even after repeatedly telling them to PLEASE call us if they need anything.

Back to nipple shields. I am sure that there are some rare cases where they can be a true blessing, but they are so hugely overused and, in my opinion, really are a danger to the success of breastfeeding. I have emailed with Dr. Jack Newman regarding nipple shields in the past, and here is some of what he had to say:

"No, a nipple shield is not better than a bottle. With the bottle, the milk supply is maintained and the chances of getting the baby to latch on are good. With the nipple shield the milk supply decreases, and that makes it more difficult to get the baby to latch on. I am appalled by the wide spread use of nipple shields by anyone, but particularly lactation consultants."

Dr. Newman totally rocks.

I just wish them shields weren't handed out like candy everywhere. :(

a decision

I am feeling like I probably won't be telling birth stories here. It feels too personal to me, like they aren't really mine to be telling, and even if I think this is an anonymous blog....on the internet, do we really have anonymity? :) I will probably include snipits about out of the ordinary events that may come up at births from a midwifery perspective, though.

But, it should be full of my musings and whatever it is that I am learning about at the moment.

Fun!

Trust Birth Conference

I'm SO excited about the upcoming Trust Birth Conference.......

Sarah Buckley, Michel Odent, Gloria Lemay, Rixa Freeze, Pamela Hines-Powell, Gail Hart, and many more!!!

Yay!!!

March 7-9, 2008 in Redondo Beach, California.

Come and join us!

While you are at it, take a look at the Trust Birth site itself. ;)

Bump.

Ok, with only a little over 6 months of a lapse, I am back. :)

I have been feeling the need practice my eloquence these days when it comes to birth, as well as have some spare moments for clarifying for myself what precisely is my philosophy about birth. So, I think that the best way for me to do that is to pick up writing once again and start babbling away. Here we go, one more time.

new year

2006 was a big year in my life.

We moved (again), my son is not a baby anymore (almost 3) and talks a mile a minute, my dss is now an unschooling teenager, and my dh (essentially) works from home now.

And, I got an apprenticeship.

It felt like I had been waiting for this my whole like...even though I didn't even know midwives existed outside of history books until I was 19. I have been apprenticing now 9 months. Some times I have to focus really hard on my daily tasks at hand because my head is constantly spinning with all of the things that I am learning and pondering all of the time.

I have had the honor at assisting at 16 births as an apprentice. Until I began this journey 9 months ago, I had only been present at 4 births (2 homebirths, one of which was a UC, and 2 hospital births)...and then of course my own son's birth at home nearly 3 years ago.

Today my preceptor talked to me about my acting as primary midwife soon. We have many, many births coming up this winter, spring and summer. This is just such an exciting time in my life.

(Am I selfish to hope that one of our upcoming clients has a breech baby and sticks with her choice to homebirth??? LOL!)

2007

My big news for 2007 is that I am getting serious about graduating from my school. I am likening it to me being in grad school full time. I am going to be BUSY...but by choice! All of the work that I have left to do just feels like it would be SO relevant to what I am doing now, so I want to get on it. I don't think that I will feel *ready* to be a midwife on my own until I am graduated or very near graduating, simply because I know what I have left to learn is vital to my practice as a midwife.

So, even though I just began blogging again, I don't think I will be posting often. Of course, when we have a birth, I will do my best to come and post and write my thoughts about it. Or, whenever any other issue that I feel needs to be talked about comes up. But, for the most part, I will be hitting the books. ;)

There have been no births for almost a month, and no clients due until the beginning of February. I am really excited for all of our clients who are coming upon their 'due' date. Birth is just so awesome!!